Lost in the debate over who to cover with health insurance and how to structure it is any meaningful discussion of how to substantially reduce the costs of these [already bloated and oversubsidized] industries, of 'Medical Care' and 'Health Insurance'.
As long as we continue the flawed "Cost-Plus" arrangements in health care that are now [thankfully] being abandoned in defense procurement, costs will continue to escalate - even if we didnt cover one additional person.
Merely extending the Medicare/Medicaid strategy of establishing "Price Supports" - minimum federal price guarantees - under every procedure, to 47 million additional victims will not only waste money, it will cost lives. There are better ways to do this...<more>
Outcomes-based Compensation, Malpractice Limitations, and Comparative Effectiveness Ratings are a start toward rationalizing a health care establishment which is loathe to face any objective evaluation or heightened competition within its ranks. But, to the extent that the purpose of health care reform is to save lives, make people healthier, and avert fiscal catastrophe, we need to contemplate more dramatic measures, which get to the roots of the cost spiral.
The great majority of health care expenditures are made due to the consequences of Obesity, Poor Diet/Nutrition, other lifestyle choices, and the long term maintenance of chronic conditions such as Diabetes, Kidney failure, Alzheimer's, etc. Of course, overpopulation - particularly among families with the least healthy lifestyles - is the ultimate culprit.
Let's consider some radical alternatives...
1. Radical Liposuction for the Morbidly Obese - Because fat cells do not multiply, but only swell and shrink, Liposuction is the only certain way of rapidly preventing a near certainty of Heart disease, Diabetes, and Orthopedic complications later in life. The safe and simple procedure, which is quickly acomplished without lengthy hospitalization, is now often done on an outpatient basis. The immediate benefits to the patient in terms of comfort, appearance, energy level, mobility, etc. are secondary considerations; the fact is that healthy life expectancy is greatly prolonged by the procedure. But, it gets better: It is now relatively easy to isolate adult Stem Cells from the extracted fat. If Radical Liposuction was fully covered, with Stem Cell recovery and cryopreservation for each patient, the projectable downstream cost savings are enormous. Needless to say, millions of tons of Carbon-neutral 'green' biofuel also result from this process, as the fat can be used to generate power directly, on-site, or collected from many such sites for industrial Biodiesel processing (as used vegetable oils and cooking fat are done today).
2. Make Organ Donation an "Opt-Out" Responsibility - The personal/religious sensibilities of all can be accommodated by changing the current organ donation standard from one of 'Opt In' to one of 'Opt Out'. As expensive as organ transplants are, the costs of maintaining Kidney patients on dialysis, Cardiac patients in ICU, etc., are much greater - and the radical expansion of transplant volume would reduce the cost of such operations dramatically.
3. Move Junk Food Subsidies to Nutritious Alternatives - One revenue positive strategy to radically improve American health and wellness is to disqualify fattening unhealthy processed foods from Food Stamp coverage, while adding nutritional supplements (vitamins, minerals, herbs) to the list instead. By facilitating the acceptance of Food Stamps by health food stores and local farmer's markets, great strides in wellness can be achieved without additional expenditures. Money currently spent to feed empty calories to the poor in the form of Trans-fats, High Fructose Corn Syrup, and other junk food should instead be reallocated to foods less likely to make them sick in the future. That's not only the logical thing to do medically, its also the only humane way to approach food subsidies. But we can go farther, by taxing the least healthy prepared foods to raise revenue for remedial health care, in the same way that alcohol and tobacco are already taxed.
4. Require Oversight by Alternative Practitioners - In many cases, 'the system' corrals patients into highly expensive procedural ordeals which are not only risky but often ineffective as well. Major examples include Orthopedic spinal surgery and Angioplasty, for which less invasive Chiropractic and Chelation alternatives, respectively, are - in most cases - demonstrably safer, cheaper, and more effective. On the pharamceutical side as well, there is no reason not to start patients on Melatonin (or Herbal preparations) for Sleep disorders, and St. John's Wort (a natural SSRI/MAOI agent) for Depression before - if necessary - moving them on to prescription drugs that are at once both [far] more expensive AND more dangerous. Multiplied throughout the health care system, the savings from just these four examples can translate to tens of billions of dollars annually.
5. Break the Physician Monopoly on Medical Imaging - If everyone covered were eligible for an annual full-body advanced imaging scan , and the scan required no doctor's prescription or referral, the effiency and effectiveness of health care in America would dramatically improve. Whether CAT, MRI, PET, SPECT, or emerging alternatives such as high resolution Ultrasound and Infrared Optical Tomography, today's imaging technology is getting cheaper to deliver; the plumetting cost of the technology does not translate into reduced cost for the service because of the present physician monopoly. Doctor's vists are required to obtain access to the service, doctors own the imaging centers, doctors steer the interpretation of the imaging to their partners and associates; its a racket. Since these imaging systems are non-invasive, harmless, and 'foolproof', there is no agrument against making them as common and commercial as Jiffy-Lube, Midas Muffler, or AAMCO Transmission shops. (Okay, leave out CAT if you have radiation issues with this...) Eliminate 'Certificate of Need' barries to the establishment of imaging centers, and allow entrepreneurs to establish ten times as many as exist currently, giving everyone vouchers for an annual scan. Given the greatly expanded market, new machines will be introduced, costing tens of thousands of dollars rather than the hundreds of thousands or millions of dollars they cost now. In this manner, the individual scan cost can be brought down from a few thousand dollars to a few hundred - and serious conditions detected before they become life threatening and far more expesnive to treat.
6. Catalyze Massive New Field Trials of Alternative Therapies - Profound results have been obtained in the treatment of Autism, Alzheimers', Attention Deficit Disorder, Parkinsonism, Diabetes, and other conditions through simple nutritional/dietary modifications alone. With respect to Autism and Alzheimers', where conventional medicine offers no meaningful treatment to begin with, the results are nothing short of astonishing. If proven in large scale trials and made the standard treatment, tens of billions of dollars can be saved annually by enabling patients to avoid institutionalization, with improved functionality at home. Leaders in the emerging field of Functional Medicine, such as Drs. Mark Hyman, Daniel Amen, Deepak Chopra, and Andrew Weil, bring substantially more to the health care debate than the AMA. Its time to take alternative therapiese seriously; we can no longer afford not to.
7. Double or Triple the Number of Medical Doctors & Registered Nurses - Through immigration incentives and tuition grants, the number of MDs and RNs at practice in the United States on a per capita basis should be [at least] doubled within 10 years, with the objective of reducing their wages by half. From any perspective, this increased availability of health care will enable more patients to be treated at a lower cost per treatment. Health care will never become affordable with $350,000 doctors and $80,000 nurses. You cant cap their compensation - since you want them to work later hours and more weekends, and even make housecalls again - but you can flood the market such that they will be forced to do so to maintain such earnings.
8. Eliminate "Standard Reimbursement" Schedules for Hospital Care - By forcing local hospitals within a metropolitan area to bid competitively for federal contracts on common procedures (i.e. Maternity, Appendectomy, Gall Bladder, etc.) and, thereby, to allow them to specialize, total costs for all such procedures within a given area can be reduced. With a 'recompete' every five years, a strong incentive can be established for hospitals to maximize their efficiency in those which they choose to compete. Current practice merely establishes the medical equivalent of agricultural "price supports", whereby no market exists for any procedure at any price below the 'floor' created by the standard Medicare/Medicaid reimbursement schedule formula. Since health care providers are prohibited by law from furnishing their services to any party at any rates below those charged to the government, the lucrative nature of the restricted market is assured. Change this, and the bottom will fall out of today's artifically inflated price structures for dozens of the most common medical/surgical procedures.
9. Make the E.R. the Primary Care Provider of Choice - Contrary to the conventional wisdom, the Emergency Rooms can in fact be the most efficient place to deliver quality care for all. If we specifically funded E.R. care for today's "uninsured", taking those financial losses off the hospital's books - and out of its overhead in pricing its compensible care services - it would be far more efficient than erecting new health insurance bureaucracies. Emergency Rooms could be greatly expanded, adding non-'emergency' clinical services, and even be replicated as stand-alone facilities apart from hospitals themselves, if they had direct funding under a national healthcare mandate. Meanwhile, user education systems can be created to train patients in when an E.R. visit is necessary (i.e. injuries) and when it is not (i.e. 'sniffles'). If there were twice as many E.R. facilities in the United States, and their cost were not a part of the hospital's overhead burden, but they were instead funded directly on a annual basis (not computed per procedure), the entire issue of health care financing could be more intelligently managed.
10. Move Reproduction Subsidies to Contraception Alternatives - In the nation's most immoral manifestation of public policy, we continue to pay poor women to reproduce with enhanced welfare benefits per each new child, as if they were prized cattle being husbanded by the State for "breeding stock". Similarly, in the tax code, additional exemptions are provided to working class, middle class, and even rich couples for each new life brought into the [already overcrowded] world. Scrap all of this, and instead offer permanent contraceptive surgeries to both men and women, and reversible alternatives such as Norplant, with the savings thus obtained. Contemporary gynecology now offers reversible sterilization surgery, while spermbanking permits men the same type of option. But we can go further. We license housepainters and cosmetologists, massage therapists, and roofers; why not parents? Should it really be more expensive - in terms of required registration, licensing, tags, taxes, insurance, inspections, doc stamps, etc. - to acquire a car, boat, motorcycle, or RV, (or to purchase a house, for that matter) than to bring a new life into the world? If we incentivized a compassionate voluntary American equivalent of China's "One Child Per Family" policy, with the goal of reducing the U.S. population from 300 Million to 250 Million within two generations and 200 Million within four generations, our problems in Health Care, Climate Change, Energy, Education, and Employment would all disappear this Century. In terms of health care cost avoidance, there can be no greater efficiency than a pregnancy which does not happen.
These ten steps are not particularly brilliant, merely rational - in an industry long perverted by greed and subsidies, for which rationality has been in short supply. Unfortunately, the current health care debate has injected no rationality into the discussion; it has degenerated into a battle over 'who to tax to buy more of the same'. More than 200,000 people are killed in the United States each year by Iatrogenic illness - medical mistakes, drug interactions, and hospital-born infections - which are caused by the health care establishment itself. This exceeds ALL deaths from Crime, Transportation Accidents, illegal Drugs, and Suicide, combined. Do we really want to buy more of it?